Someone to watch over me: Concierge or retainer medicine new trend in health care

On a recent Monday evening, Bonita resident Jim Fauver began feeling sick after dinner, experiencing intense stomach pain. After a restless night, he made a doctor’s appointment for the next morning.

Fauver’s physician, Dr. Richard Kravis of Naples Healthcare Associates, did an examination and tests, and then had Fauver take it a step further by having a CT Scan. The doctor told Fauver he would call him the next day with the results.

“The next day I felt better and thought it was nothing,” said Fauver. “Then I received a call from Dr. Kravis, telling me to meet him at the hospital for emergency surgery.”

He had acute appendicitis.

Kravis was waiting for his patient when he arrived. “He was the first doctor I saw, and he stayed with me for about three hours that night in the emergency room,” said Fauver. “And he was the first person I saw when I got out of surgery.”

Fauver had just gone through medical problems and a hospital stay with his in-laws.

“It’s extremely stressful. When we were at that hospital, we were afraid to even leave the room for coffee, so we wouldn’t miss news from the doctor.”

In his case, Fauver said, his own doctor was there with him a significant amount of the time. “It was the epitome of having someone watch over me, someone who knows me and cares about me. It took a majority of the stress out of the situation.”

Fauver had an emergency appendectomy. If the condition had not been diagnosed so quickly with the thorough testing he received, it could have resulted in a medical emergency such a ruptured appendix. Instead, Fauver has a small scar from the minimally invasive laparoscopic surgery, and in a week he was ready to go on a planned vacation.

Today, this type of scenario, where a doctor follows a patient through surgery, is rare.

“It wasn’t unusual years ago,” said Kravis. “I actually spend time with patients. It’s the kind of medicine I want to practice.”

Fauver is part of the physician’s Patient Advantage Program at Naples Healthcare Associates, in which he and other patients pay a yearly fee for “Concierge” or retainer medicine for premiere heath care services. He has 24-hour access to the same doctor, one he trusts and believes personally cares for him, who knows his medical history inside and out. In fact, he has the cell phone number of the doctor, to be able to reach him directly night or day. “I can’t say enough about how great the program is,” he said.

Retainer medicine is now becoming a trend across the county. Kravis’ group was the first to start it in the Naples area.

“It’s the way medicine is supposed to work,” said Kravis. “The current health care system is a disconnect. Doctors see over 40 patients a day. With our program, you can call us directly, and get appointments within 24 hours. We even make house calls.”

The benefit of house calls, according to Kravis, allows some patients to be more independent, and stay in their homes longer versus feeling they have to live in an assisted living facility.

Concierge or retainer medicine is popular in many major cities, from Boston to New York, Seattle to Minneapolis, and throughout Florida. Patients get more personalized service, and doctors like Kravis say they get to practice the type of medicine they entered the field to do.

These medical programs are usually structured as membership programs with patients paying annual membership fees for extra service and amenities. While the level of service and amenities can vary widely, a common theme for all “concierge” type programs is greater accessibility to the physician.

Kravis looked at other programs across the country before starting the first in this area several years ago. According to the physician, prices, levels of service and amenities vary from program to program. “They can go from $2,500 up to $30,000,” he said.

His program charges $5,000 for an individual and $8,000 for a family. Kravis, a former board member with Health Texas and the Baylor Health Care System of Dallas, is joined in his practice by Donald J. DiPasco, M.D., former chief of staff at St. Joseph Hospital in St. Louis and Joseph A. Stafford, former chief of staff and medical director at Leelanau Memorial Health Center in Northport, MI. They run the Patient Advantage Program together from their medical offices off Immokalee Road.

Kravis said there are certain things individuals should investigate before joining a program. His practice, which is internal medicine, is best suited for adult patients. “We’re like the Ben Caseys and Dr. Kildares that can follow a patient in and out of the hospital.”

Those with children are better off with family practitioners, he said. There are a few other local groups of both that do retainer medicine in Naples, and one in Fort Myers.

“You also need to look at the physician’s credentials,” Kravis said. Do they have privileges at your hospital of choice, or all local hospitals? He also said he believes a strong civic and health care community background makes for a better choice of physician.

Kravis also said to look at the amenities being offered. “What do you want? Do you want house calls, complete physical exams, follows to the hospital?” He stated that the patient should question the doctor before signing up for any retainer medicine program.

“People don’t realize how broken the health care system is until they get sick,” said Kravis. “With our system we treat our patients wherever they are; in the hospital, in our office, in their home or in a rehab or specialty facility. Is it typical for a doctor to follow a patient through rehab or to Assisted Living? No. Again, 40 years ago it was normal.”

Kravis believes this type of medicine is here to stay, and will only get more popular in the future.

“Will we return to the good old days of heath care? No. Today’s system treats patients as numbers and has shifted its focus from quality, service and compassion to a one-size-fits-all production line mentality. Doctors are faced with decreasing payments from Medicare and insurance companies while their malpractice insurance and other costs are skyrocketing. That’s why people are turning to concierges medicine,” he said.

Kravis also believes in comprehensive physical examinations. He said that in three separate cases, the more thorough exams in his program resulted directly in the early detection of serious disorders including cancer, and all three patients benefited greatly from the early detection.

“It’s worth it,” says Fauver, who strongly believes in the program. “The hospital experience is the main reason. Usually the family goes through so much stress when a loved one is in the hospital. My wife or I would have had to fly someone in. In my case, my family didn’t have to go through that stress. My doctor was there.”